A new improved technique for placement of a pursestring suture on the edge of the distal part of the rectal stump using a skin stapler for low anterior resection.

Instead of a linear stapler or manual pursestring suture onto the lower part of the rectum, we placed a No. 2-0 Prolene suture on the edge of the rectal stump, using 12 to 16 clips and a disposable skin stapler. This technique is satisfactory for very low anterior resection.

Early malignant histiocytosis of the intestine: an autopsy report.

A 63-year-old man with malignant histiocytosis of the intestine died 3 days after gastrectomy for early gastric adenocarcinoma. Malignant histiocytosis of the intestine was unexpectedly found at autopsy. The intestine was thickened with mucosal erosions. Histologically, a few atypical large histiocyte-like cells were found in focal aggregates in the mucosa. These large cells expressed the T-cell antigen and monoclonality was demonstrated by the polymerase chain reaction showing variable-joining segment rearrangement in the T-cell receptor delta-chain gene. Malignant histiocytosis of the intestine was thus diagnosed.

Revascularized diabetic limbs: positional changes in regional perfusion index.

We measured pre- and postoperative ankle:brachial index (ABI), regional perfusion index (RPI = foot/chest transcutaneous oxygen tension [TcpO2]), and variation in RPI with limb elevation in 22 ischemic lower extremities of 20 patients to compare ABI and RPI measurements for quantifying limb perfusion and analyze perioperative positional changes in RPI. Measurements were compared, using t tests, with all limbs grouped according to severity of clinical ischemia and, again, according to presence or absence of diabetes. Preoperative mean and mean post-revascularization increases in ABI values ranged from 0.27 to 0.48 and 0.40 to 0.54, respectively; corresponding RPI values ranged from 0.18 to 0.45 and 0.48 to 0.60, respectively. Pre- and postoperative decreases in RPI with elevation ranged from 0.07 to 0.11 and 0.11 to 0.23, respectively. ABI and RPI values were equally effective in assessing clinical ischemia preoperatively and increased perfusion postoperatively, regardless of degree of ischemia or diabetes. Upon elevation, all limbs exhibited larger decrements in blood flow to the skin postoperatively compared to preoperatively, as estimated by RPI. However, postoperative positional decrease in RPI was greater in diabetics compared with nondiabetics (0.23 +/- 0.12 vs 0.12 +/- 0.06; P < 0.05), suggesting postoperative elevation of diabetic limbs with ischemic skin lesions may be unadvisable.

Radical lymphadenectomy for rectal cancer facilitated by a carbon particle infusion lymphangiography.

For the intraoperative visualization of the para-aortic nodes and those around the iliac vessels, a fine carbon particle solution was infused into the bilateral pedal lymphatic vessels of 12 patients with rectal carcinoma. A low anterior resection with radical lymph node dissection was then performed while preserving pelvic autonomic nerves. Of 444 lymph nodes removed from the iliac arterial region, 430 were stained with carbon black (96.8%), even though the black staining was not perfect in the nodes of the inferior mesenteric arterial region. All of the lateral black stained nodes were clearly visible and hence could be easily excised. The average number of dissected nodes in one patient was 43.8 in this dissection with carbon particle infusion, which was larger than those of conventional lymph node dissection. We then examined the length of time that a postoperative indwelling bladder catheter was needed as an indication for autonomic nerve damage, and it was ascertained that less damage occurred in this operation compared to other types of dissections, such as conventional or extended lymph node dissection.

[Effect of splenectomy in gastric carcinoma surgery on cell-mediated immunity; evaluation with alteration of peripheral blood lymphocyte subsets].

Peripheral blood lymphocyte subsets were studied in 70 patients who underwent gastrectomy for gastric carcinoma. Lymphocyte subsets were analysed before and after gastrectomy by use of monoclonal antibody for cell membrane markers. There were significant differences in the gastrectomized patients with splenectomy compared to the patients without splenectomy in postoperative changes of lymphocyte subsets as follows. Decrease of OKT4 and increase of OKT8. Temporary decrease of B-1. Continuous increase of Leu-7. These results suggest that gastrectomized patients with splenectomy show a decrease in helper activity, an increase of suppressor activity of T lymphocytes and a compensatory increase of population of natural killer cells in association with suppression of natural killer activity.